Progressive Resistance Exercise
&
Mechanical Resistance Exercise
DR. FAIROUZ HATEM AMEEN
Progressive Resistance Exercise 2
Progressive Resistance Exercise PRE: is a
system of dynamic resistance training in
which a constant external load is applied to
the contracting muscle by some
mechanical means (usually a free weight or
weight machine) and gradually increased.
The RM is used as the basis for determining
and progressing the resistance.
What is the appropriate load to work with?
3
InitialExercise Load (Amount of Resistance)
is always challenging to estimate.
How much resistance to apply manually or
how much weight a patient should use
during resistance exercises to improve
muscle strength particularly at the beginning
of a strengthening program.
Repetition Maximum 4
Is one method of calculating an appropriate
exercise load for training and measuring the
effectiveness of a resistance exercise
program.
This term was first reported decades ago by
DeLorme in his investigations of an approach
to resistance training called progressive
resistive exercise (PRE).
5
A repetition maximum (RM) is
defined as: the greatest amount of
weight (load) a muscle can move
through the full, available ROM with
control, a specific number of times
before fatiguing.
Use of a repetition maximum: 6
There are two main reasons for determining a
repetition maximum:
(1) To document a baseline measurement of
the dynamic strength of a muscle or muscle
group against which exercise-induced
improvements in strength can be compared.
(2) To identify an initial exercise load (amount
of weight) to be used during exercise for a
specified number of repetitions.
7
DeLorme reported use of a 1-RM: (the
greatest amount of weight a subject can
move through the available ROM just one
time) as the baseline measurement of a
subject’s maximum effort.
Although he used a multiple RM, specifically
a 10-RM, (the amount of weight that could
be lifted and lowered 10 times through the
ROM) during training.
A therapist select a specific amount 8 of
resistance (weight) by estimation and document
how many repetitions can be completed
through the full range before the muscle begins
to fatigue.
If six repetitions, for example, were completed,
the baseline resistance would be based on a 6-
RM.
Remember, a sign of fatigue is the inability to
complete the full, available ROM against the
applied resistance.
Advantages of the repetition 9
maximum method:
Safe and reliable measurement
tool prior to beginning conditioning
programs
Precaution: 10
-Use of a 1-RM as a baseline measurement of
dynamic strength is inappropriate for some
patients because it requires one maximum effort.
-It is not safe for patients with joint impairments.
-Patients who are recovering from or who are at
risk for soft tissue injury.
-Patients at risk for osteoporosis or cardiovascular
pathology.
Training zone 11
Training Zone: a percentage of a 1-RM used at
the initiation of resistance training.
At the beginning of an exercise program for
sedentary, untrained individuals the percentage
necessary to achieve training-induced
adaptations in strength is low (30% to 40%) of RM.
For already highly trained use (>80%) of RM.
For healthy but untrained adults, a typical training
zone usually falls between 40% and 70% of the
baseline RM.
12
The lower percentage of this range is safer at the
beginning of a program to enable an individual
to focus on learning correct exercise form and
technique before progressing the exercise load
to 60% to 70%.
For patients with significant deficits in muscle
strength or to train for muscular endurance, using
a low load—possibly at the 30% to 50% level—is
safe yet challenging.
Alternative Methods of Determining 13
Baseline Strength or an Initial
Exercise Load:
-Cable tensiometry and isokinetic or
handheld dynamometry are alternatives to
a repetition maximum for establishing a
baseline measurement of dynamic or static
strength.
Delorme and Oxford Regimens 14
The concept of PRE was introduced
over 60 years ago by DeLorme, who
proposed the use of three sets of a
percentage of a 10-RM with progressive
loading during each set.
The Oxford technique was then
developed with regressive loading in
each set.
15
The DeLorme technique builds a warm-up
period into the protocol, whereas the
Oxford technique diminishes the resistance
as the muscle fatigues. Both regimens
incorporate a rest interval between sets;
both increase the resistance gradually over
time to apply progressive overload; and
both have been shown to result in training-
induced strength gains.
Table1: Comparison of Two PRE Regimens
16
DeLorme Regimen Oxford Regimen
Determination of a 10-RM Determination of a 10-RM
10 reps @ 50% of the 10 RM 10 reps @ 100% of the 10-RM
10 reps @ 75% of the 10-RM 10 reps @ 75% of the 10-RM
10 reps @ 100% of the 10-RM 10 reps @ 50% of the 10-RM
Warming up No warming up
Causes more fatigue Causes less fatigue
DAPRE Regimen: 17
Acommon guideline for increasing the
load of the exercise is to increase the
weight by 5% to 10% when all
prescribed repetitions and sets can be
completed easily without significant
fatigue.
18
The Daily Adjustable Progressive Resistive Exercise
(DAPRE) technique is more systematic and takes into
account the different rates at which individuals
progress during rehabilitation or conditioning
programs. The system is based on a 6-RM working
weight.
The adjusted working weight, which is based on the
maximum number of repetitions possible using the
working weight in Set #3 of the regimen, determines
the working weight for the next exercise session
(Table 2).
Table 2: DAPRE technique 19
Sets Repetitions Amount of Resistance
1 10 50% 6-RM
2 6 75% 6-RM
3 Maximum possible 100% 6-RM
4 Maximum possible 100% adjusted working weight
Muscle fatigue: 20
Muscle fatigue: the diminished response of
muscle to a repeated stimulus is reflected in
a progressive decrease in the amplitude of
motor unit potentials.
This occurs during exercise when a muscle
repeatedly contracts statically or
dynamically against an imposed load.
21
This acute physiological response to
exercise is normal and reversible.
It is characterized by a gradual decline in
the force-producing capacity of the
neuromuscular system that is, a temporary
state of exhaustion (failure), leading to a
decrease in muscle strength.
22
The diminished response of muscles is caused by:
1- Decrease in energy stores.
2- Insufficient oxygen.
3- Reduced availability of intracellular calcium.
4- Reduced excitability at the neuromuscular
junction.
5- Inhibitory influences from the central nervous
system.
The fiber-type distribution of a muscle, which can be
23
divided into two broad categories (type I and type II):
Type II (phasic, fast-twitch) muscle fibers are further divided into
two additional classifications (types IIA and IIB) based on
contractile and fatigue characteristics.
In general, type II fibers generate a great amount of tension
within a short period of time, with type IIB being geared toward
anaerobic metabolic activity and having a tendency to fatigue
more quickly than type IIA fibers.
Type I (tonic, slow-twitch) muscle fibers generate a low level of
muscle tension but can sustain the contraction for a long time.
Type I are geared toward aerobic metabolism, as are type IIA.
However, type I fibers are more resistant to fatigue than type IIA.
Because different muscles are composed of varying
24
proportions of tonic and phasic fibers, their function becomes
specialized.
For example, a heavy distribution of type I (slow twitch, tonic)
fibers is found in postural muscles, which allows muscles, such
as the soleus, to sustain a low level of tension for extended
periods of time to hold the body erect against gravity or stabilize
against repetitive loads.
On the other hand, muscles with a large distribution of type IIB
(fast twitch, phasic) fibers, such as the gastrocnemius or biceps
brachii, produce a great burst of tension to enable a person to
lift the entire body weight or to lift, lower, push, or pull a heavy
load but fatigue quickly.
When fatigue develop during resistance exercise,
25
it is time to decrease the load on the exercising
muscle or stop the exercise and shift to another
muscle group to allow time for the fatigued
muscle to rest and recover.
Cardiopulmonary (general) fatigue: This type of
fatigue is the diminished response of an individual
(the entire body) as the result of prolonged
physical activity, such as walking, jogging,
cycling, or repetitive lifting or digging. It is related
to the body’s ability to use oxygen efficiently.
26
Mechanical resistance exercises
Mechanical Resistance Exercise: 27
Mechanical Resistance Exercise: is a form of
active-resistive exercise in which resistance is
applied through the use of equipment or
mechanical apparatus.
The amount of resistance can be measured
quantitatively and progressed over time.
It is also useful when the amount of resistance
necessary is greater than what the therapist can
apply manually.
Advantages of mechanical Resistance 28
Exercise:
1- Establishes a quantitative baseline measurement of
muscle performance to follow up the improvements.
2- Most appropriate during intermediate and
advanced phases of rehabilitation when muscle
strength is 4/5 or greater or when the strength of the
patient exceeds the therapist’s strength.
3- Provides loads more than manual resistance
applied by a therapist to induce a training effect for
already strong muscle groups.
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4-
Provides quantitative documentation of increases in
the amount of resistance.
5-
Quantitative improvement is an effective source of
motivation for the patient.
6-Useful for improving dynamic or static muscular
strength.
7-
High-velocity resistance training is possible and safe
with some forms of mechanical resistance.
8-
Appropriate for independent exercise in a home
program.
Disadvantages of mechanical 30
Resistance Exercise:
1- Not appropriate when muscles are very weak or soft
tissues are in the very early stages of healing, with the
exception of some equipment that provides assistance,
support, or control against gravity as the CPM.
2-
Equipment that provides constant external resistance
maximally loads the muscle at only one point in the ROM.
3- Expense for purchase and maintenance of equipment.
Determinants of Resistance Exercise: 31
Many elements (variables) determine whether a resistance exercise program is
appropriate, effective, and safe.
1-Alignment
2-Stabilization
3-Intensity
4- Volume
5-Exercise Order
6- Frequency
7- Duration
8- Rest intervals
9- Modes of exercises
10- Velocity of exercises
1-Alignment: 32
1-Alignment: to strengthen a specific
muscle or muscle group effectively and
avoid substitute motions, appropriate
positioning of the body and alignment
of a limb or body segment are essential.
Proper alignment is determined by the
direction of muscle fibers and the line of
pull of the muscle to be strengthened.
2-Stabilization: 33
2-Stabilization:refers to holding down a body
segment or holding the body steady.
■ External stabilization can be applied
manually by the therapist or sometimes by
the patient with equipment, such as belts
and straps, or by a firm support surface, such
as the back of a chair or the surface of a
treatment table.
■ Internal stabilization is achieved by an 34
isometric contraction of an adjacent muscle group
that does not enter into the movement pattern but
holds the body segment of the proximal attachment
of the muscle being strengthened firmly in place
(proximal stabilization).
For example, when performing a bilateral straight leg
raise, the abdominals contract to stabilize the pelvis
and lumbar spine as the hip flexors raise the legs.
This form of stabilization is effective only if the fixating
muscle group is strong enough or not fatigued.
3-Intensity: 35
3-Intensity: is the amount of resistance
(weight) imposed on the contracting
muscle during each repetition of an
exercise.
The amount of resistance is also referred to
as the exercise load (training load) which is
the extent to which the muscle is loaded or
how much weight is lifted, lowered, or held.
36
Submaximal Versus Maximal Exercise
Loads: the patient’s age, general health,
and fitness level; and other factors,
determine whether the exercise is
carried out against submaximal or
maximal muscle loading.
TABLE 3 Indications for Low-Intensity Versus High-Intensity Exercise
37
Submaximal Loading Maximal Loading
In the early stages of soft tissue healing when injured When the goal of exercise is to increase muscle strength
tissues must be protected. and power and possibly increase muscle size.
After prolonged immobilization when the articular cartilage For healthy adults in the advanced phase of a rehabilitation
is not able to withstand large compressive forces or when program after a musculoskeletal injury in preparation for
bone demineralization may have occurred, which increase returning to high-demand occupational or recreational
the risk of pathological fracture to evaluate the patient’s activities.
response to resistance exercise, especially after an extended
period of inactivity.
When initially learning an exercise to emphasize the In a conditioning program for individuals with no known
correct form. pathology.
For most children or older adults. For individuals training for competitive weight lifting or
body building
When the goal of exercise is to improve muscle endurance.
To warm-up and cool-down prior to and after a session of
exercise.
During slow-velocity isokinetic training to minimize
compressive forces on joints.
4- Volume: 38
Volume: In resistance training the volume of
exercise is the summation of the total
number of repetitions and sets of a particular
exercise during a single exercise session
times the intensity of the exercise.
The same combination of repetitions and
sets is not and should not be used for all
muscle groups.
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There is an inverse relationship between the
sets and repetitions of an exercise and the
intensity of the resistance.
The higher the intensity (load), the lower the
number of repetitions and sets possible.
Conversely, the lower the load, the greater
the number of repetitions and sets possible.
Therefore, the exercise load directly dictates
how many repetitions and sets are possible.
Repetitions: The number of refers to the number
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of times a particular movement is repeated.
The “average,” untrained adult, when exercising with a
load that is equivalent to 75% of the 1-RM, is able to
complete approximately 10 repetitions before needing
to rest.
At 60% intensity about 15 repetitions are possible, and at
90% intensity only 4 or 5 repetitions are usually possible.
No optimal number for strength training or endurance
training has been identified.
Training effects (greater strength) have been reported
employing a 2- to 3-RM to a 15-RM.
41
Sets: A number of consecutive repetitions
grouped together is known as a set or bout of
exercise.
After each set of a specified number of
repetitions, there is a brief interval of rest.
For example, during a single exercise session to
strengthen a particular muscle group, a patient
might be directed to lift an exercise load 10
times, rest, and then lift the load another 10
times. That would be two sets of 10 repetitions.
5-Exercise Order: 42
Exercise Order: The sequence in which exercises are
performed during an exercise session has an impact on
muscle fatigue and adaptive training effects.
When several muscle groups are exercised in a single
session, large muscle groups should be exercised
before small muscle groups, and multi-joint exercises
should be performed before single-joint exercises.
In addition, after an appropriate warm-up, higher
intensity exercises should be performed before lower
intensity exercises.
6- Frequency: 43
Frequency: the number of exercise sessions per
day or per week, frequency is dependent on
other determinants, such as intensity and volume
as well as the patient’s goals, general health
status, previous participation in a resistance
exercise program, and response to training.
The greater the intensity and volume of exercise,
the more time is needed between exercise
sessions to recover from the temporarily fatiguing
effects of exercise.
44
A common cause of a decline in performance
from overtraining is excessive frequency,
inadequate rest intervals, and progressive
fatigue.
Some forms of exercise should be performed less
frequently than others because they require
greater recovery time.
A frequency of 2 to 3 times per week, every other
day, or up to five exercise sessions per week is
common
7- Duration 45
Duration: Exercise duration is the total
number of weeks or months during
which a resistance exercise program is
carried out.
8-Rest Interval (Recovery Period): 46
Rest Interval: is a critical element of a resistance
training program and is necessary to allow time
for the body to recover from the acute effects
of exercise associated with muscle fatigue.
Rest intervals for each exercising muscle group
are dependent on the intensity and volume of
exercise.
In general, the higher the intensity of exercise
the longer the rest interval.
47
For moderate-intensity resistance training, a 2- to
3-minute rest period after each set is
recommended.
A shorter rest interval is adequate after low-
intensity exercise.
Longer rest intervals (>3 minutes) are appropriate
with high-intensity resistance training, particularly
when exercising large, multi-joint muscles, such
as the hamstrings, which tend to fatigue rapidly.
48
Tip:
While the muscle group that was just
exercised is resting, resistance exercises can
be performed by another muscle group in
the same extremity or by the same muscle
group in the opposite extremity.
9-Mode of exercise: 49
Mode of exercise: refers to:
the form of exercise,
the type of muscle contraction that occurs,
the manner in which the exercise is carried
out.
For
example, a patient may perform an exercise
dynamically or statically or in a weight-bearing or
nonweight-bearing position, resistance applied
manually or mechanically
Type of Muscle Contraction: Isometric or dynamic
50
muscle contractions are two broad categories of
exercise.
Dynamic resistance exercises can be performed using
concentric(shortening) or eccentric(lengthening)
contractions, or both.
51
Modes of exercise also can be classified by
the energy systems used during the
exercise.
Anaerobic exercise involves high intensity
(near-maximal) exercise carried out for a
very few number of repetitions because
muscles rapidly fatigue.
Strengthening exercises fall into this
category.
52
Aerobic exercise is associated with low-
intensity, repetitive exercise of large muscle
groups performed over an extended period
of time.
This mode of exercise primarily increases
muscular and cardiopulmonary endurance.
Mechanical resistance exercises: A constant53 or
variable load can be imposed using mechanical
resistance (e.g., free weights or machines).
Isokinetic contraction: When the velocity of limb
movement is held consistent by a rate-controlling
device, the term isokinetic contraction is used.
Accommodating resistance can be
implemented by use of an isokinetic
dynamometer that controls the velocity of active
movement during exercise.
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Range of Movement: Short-Arc or Full-Arc Exercise 55
Resistance through the full, available range of
movement (full-arc exercise) is necessary to
develop strength through the ROM.
Sometimes resistance exercises are performed
through only a portion of the available range.
This is known as short arc exercise.
This form of exercise is used to avoid a painful arc
of motion or a portion of the range in which the
joint is unstable or to protect healing tissues after
injury or surgery.
10-Velocity of exercise: 56
Velocity of exercise: The velocity at which a
muscle contracts significantly affects the tension
that the muscle produces and subsequently
affects muscular strength and power.
The velocity of exercise is frequently
manipulated in a resistance training program to
prepare the patient for a variety of functional
activities that occur across a wide spectrum of
slow to fast velocities.
The force-velocity relationship is different
57
during concentric and eccentric muscle
contractions.
Concentric Muscle Contraction: During a
maximum concentric muscle contraction,
as the velocity of muscle shortening
increases, the force the muscle can
generate decreases because the muscle
may not have sufficient time to develop
peak tension.
Eccentric Muscle Contraction: During 58 a
maximum eccentric contraction, as the
velocity of active muscle lengthening
increases, force production in the muscle
initially increases to a point but then quickly
levels off.
The initial increase in force production may
be a protective response of the muscle
when it is first overloaded. This increase may
be important for shock absorption.
General Principles of Resistance Training:59
Warm-Up Prior to initiating resistance exercises,
warm-up with light, repetitive, dynamic,
movements without applying resistance.
Placement of Resistance: resistance is applied to
the distal end of the segment in which the
muscle to be strengthened attaches.
Distal placement of resistance generates the
greatest amount of external torque with the least
amount of manual or mechanical resistance
(load).
Stabilization: to avoid unwanted, substitute motions.
60
Rest intervals to prevent fatigue.
Verbal Instructions: use simple instructions that are
easily understood.
Monitoring the Patient: Assess the patient’s responses
before, during, and after exercise.
Cool down period:after resistance exercises perform
rhythmic, unresisted movements, such as arm swinging,
walking, or stationary cycling. Gentle stretching is also
appropriate after resistance exercise.
61
Isokinetic Exercise: is a form of dynamic
exercise in which the velocity of muscle
shortening or lengthening and the angular
limb velocity is predetermined and held
constant by a rate-limiting device known as
an isokinetic dynamometer
The term isokinetic refers to movement that
occurs at an equal (constant) velocity.
Isokinetic machine 62
63
Recap
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